Breast cancer: black women would benefit from being screened earlier

Should breast cancer screening guidelines, in particular age, be better adapted to women’s ethnic origin? This is the question posed by a new study published Wednesday in the journal JAMA Network Open. According to clinical trials and previous results analyzed of mortality taking into account ethnicity, black women could be recommended to start screening at a younger age, around 42 years old instead of the usual 50, to compensate for higher mortality. higher than in other populations at the same age. Moreover, the age at which to start screening remains a constant concern of the recommendation authorities.

Not all women have the same risk at the same age

In an international study, researchers – from China, Germany, Sweden, Switzerland and Norway – analyzed data on 415,277 women in the United States who died of breast cancer between 2011 and 2020, from the National Center for Health Statistics. When the researchers looked at the data by ethnicity and age, they found that:

• The breast cancer death rate among women in their 40s was 27 deaths per 100,000 people/year among black women versus 15 deaths per 100,000 people/year among white women;
• And 11 deaths per 100,000 people/year among Native American, Alaska Native, Hispanic, and Asian or Pacific Islander women.

In other words, 0.027% of black women between the ages of 40 and 49 die of breast cancer each year. In general, for women in the United States, their average risk of dying from breast cancer in the decade after reaching age 50, from ages 50 to 59, is 0.329%, according to the study. .

“However, this level of risk is reached at different ages for women of different racial/ethnic groups,” said Madhi Falla first author of the study.

• According to statistics, black women tend to reach this level of risk 0.329% earlier, at age 42;
• White women tend to hit it at age 51;
• Native American or Alaska Native and Hispanic women at age 57;
• Asian or Pacific Islander women later at age 61.

Thus, the researchers determined that when breast cancer screening was recommended at age 50 for women, black women should start at age 42. However, while this study confirms that the age of breast cancer mortality is younger among black women, it does not determine the reasons for this inequality.

Breast cancer screening differs according to the population: equality VS equity

This new study raises an important point, say the authors: Health policymakers should seek equity, not just equality, in breast cancer screening as a tool to help reduce death rates. .

However, the study clarifies that this difference in risk is not the result of black women not adhering to current mammography guidelines: nationwide, 3 out of 4 women, whether black, white, Hispanics and Asians follow the recommendations. But black women have an almost three times higher risk of triple-negative breast cancer. These particular types of cancers tend to be more common in women under 40, grow faster than other types of invasive breast cancer, and have fewer treatment options.

Black women also tend to have denser breast tissue than white women. The presence of dense breast tissue can make it more difficult for radiologists to identify breast cancer on a mammogram, and women with dense breast tissue have a higher risk of breast cancer.

But these biological differences between women are only a small part of a much larger discussion about racial disparities.